Influenza Surveillance in 15 Countries in Africa, 2006–2010

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BackgroundAcute respiratory infections (ARIs) are a major cause of morbidity and mortality worldwide. Influenza typically contributes substantially to the burden of ARI, but only limited data are available on influenza activity and seasonality in Jordan.MethodsSyndromic case definitions were used to identify individuals with severe acute respiratory infections (SARI) admitted to four sentinel hospitals in Jordan. Demographic and clinical data were collected. Nasopharyngeal and oropharyngeal swabs were tested for influenza using real‐time reverse transcription polymerase chain reaction and typed as influenza A or B, with influenza A further subtyped.ResultsFrom January 2008–February 2014, 2891 SARI cases were tested for influenza, and 257 (9%) were positive. While 73% of all SARI cases were under 5 years of age, only 57% of influenza‐positive cases were under 5 years of age. Eight (3%) influenza‐positive cases died. An annual seasonal pattern of influenza activity was observed. The proportion of influenza‐positive cases peaked during November–January (14–42%) in the non‐pandemic years.ConclusionsInfluenza is associated with substantial morbidity and mortality in Jordan. The seasonal pattern of influenza aligns with known Northern Hemisphere seasonality. Further characterization of the clinical and financial burden of influenza in Jordan will be critical in supporting decisions regarding disease control activities.

Section: Discussionsupporting

confidence: 64%

“…The proportion of influenza‐positive SARI cases (9%) compared well with that of similar surveillance systems in Asia (8%,12 9%13) and Africa (10%,14 11%15). In addition, the system readily detected the emergence of the 2009 influenza pandemic.…”

Section: Discussionmentioning

confidence: 67%

Influenza hospitalization epidemiology from a severe acute respiratory infection surveillance system in Jordan, January 2008–February 2014

Alabdallat

Dawson

Haddadin

et al. 2016

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“…The influenza virus detection rate may vary in different locations in Zambia; however, this could not be investigated. Nonetheless, the influenza virus detection rate among SARI cases was found to be similar across 15 African countries including Zambia (median: 8.9%; interquartile range: 5.7%‐11.6%),4 and our rates of SARI and influenza‐associated SARI hospitalizations were similar to those obtained from population‐based surveillance in other African countries 19, 20, 21. In addition, we used bootstrapping for the calculation of the CIs to account for the level of uncertainty associated with all adjustments used in our estimation approach as previously reported 14, 15.…”

Section: Discussionmentioning

confidence: 90%

The national burden of influenza‐associated severe acute respiratory illness hospitalization in Zambia, 2011‐2014

Theo

Tempia

Cohen

et al. 2017

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BackgroundEstimates of influenza‐associated hospitalization are limited in low‐ and middle‐income countries, especially in Africa.ObjectiveTo estimate the national number of influenza‐associated severe acute respiratory illness (SARI) hospitalization in Zambia.MethodsWe conducted active prospective hospital‐based surveillance for SARI at the University Teaching Hospital (UTH) situated in Lusaka Province during 2011‐2014. Upper respiratory tract samples were tested for influenza virus using a reverse transcriptase polymerase chain reaction assay. We estimated age‐specific rates of influenza‐associated SARI hospitalizations for the UTH using census and secondary data on respiratory hospitalizations following estimation approaches recommended by the World Health Organization. We used the UTH hospitalization rates as a proxy for Lusaka Province. These rates were adjusted for each of the remaining 9 provinces based on their prevalence of risk factors for pneumonia and healthcare‐seeking behavior. Rates were expressed per 100,000 population.Results SARI cases accounted for 77.1% (13 389/17 354) of respiratory admissions at the UTH; 82.7% (11 859/14 344) and 50.8% (1530/3010) among individuals aged <5 and ≥5 years, respectively. Among SARI cases tested, the influenza virus detection rate was 5.5% (152/2734), 4.8% (48/998), and 6.0% (104/1736) among individuals aged <5 and ≥5 years, respectively. The mean annual national number of influenza‐associated SARI hospitalizations was 6181 (95% CI: 4321‐8041—rate: 43.9; 95% CI: 30.7‐57.1); 4669 (95% CI: 3287‐6051—rate: 187.7; 95% CI: 132.1‐243.3) among children aged <5 years; and 1512 (95% CI: 1037‐1987—rate: 13.1; 95% CI: 9.0‐17.2) among individuals aged ≥5 years.ConclusionsThe burden of influenza‐associated SARI hospitalizations was substantial and was highest among children aged <5 years.

“…3 The more widespread use of the familiar IMCI/IMAI pneumonia guidelines for influenza surveillance in resource‐poor countries—where healthcare personnel are limited, healthcare systems are overburdened, 18 and influenza seasonality is less discrete 2—could allow for the integration of hospital‐based influenza surveillance into broader pneumonia surveillance platforms that may be more sustainable. It could also allow for influenza burden and epidemiology to be described in the context of a more familiar clinical and public health syndrome—pneumonia—that resonates widely with global health policymakers like the Gates Foundation and GAVI,5, 6 dovetails with the UN's Millennium Development Goals 19 and is more easily recognizable to clinicians 8…”

Section: Discussionmentioning

confidence: 99%

“…Many sentinel surveillance systems for hospitalized influenza, particularly in resource‐poor settings, have focused on identifying cases of severe acute respiratory illness (SARI) 1, 2 In 2013, the WHO published a SARI case definition for use in global influenza surveillance (Table 1). 3 Although the SARI case definition has been widely used for surveillance, policymakers and clinicians are more familiar with pneumonia, rather than SARI, as a clinical respiratory syndrome that causes morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Comparison of severe acute respiratory illness (sari) and clinical pneumonia case definitions for the detection of influenza virus infections among hospitalized patients, western Kenya, 2009‐2013

Makokha

Mott

Njuguna

et al. 2016

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Although the severe acute respiratory illness (SARI) case definition is increasingly used for inpatient influenza surveillance, pneumonia is a more familiar term to clinicians and policymakers. We evaluated WHO case definitions for severe acute respiratory illness (SARI) and pneumonia (Integrated Management of Childhood Illnesses (IMCI) for children aged <5 years and Integrated Management of Adolescent and Adult Illnesses (IMAI) for patients aged ≥13 years) for detecting laboratory‐confirmed influenza among hospitalized ARI patients. Sensitivities were 84% for SARI and 69% for IMCI pneumonia in children aged <5 years and 60% for SARI and 57% for IMAI pneumonia in patients aged ≥13 years. Clinical pneumonia case definitions may be a useful complement to SARI for inpatient influenza surveillance.